Posts filed under ‘Desinfection and Sterilization’

Back to basics: hand hygiene and isolation

Current Opinion in Infectious Diseases: August 2014 – Volume 27 – Issue 4 – p 379–389

Huang, Gene K.L.a; Stewardson, Andrew J.a,b,d; Grayson, Michael L.a,b,c,d

Purpose of review

Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions.

Recent findings

Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission.

Summary

Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2014/08000/Back_to_basics___hand_hygiene_and_isolation.13.aspx?WT.mc_id=HPxADx20100319xMP

PDF (CLIC en ARTICLE as PDF)

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June 30, 2018 at 10:54 am

Selective digestive and oropharyngeal decontamination in medical and surgical ICU patients: individual patient data meta-analysis

Clinical Microbiology abd Infection May 2018 V.24 N.5 P.505-513

N.L. Plantinga, A.M.G.A. de Smet, E.A.N. Oostdijk, E. de Jonge, C. Camus, W.A. Krueger, D. Bergmans, J.B. Reitsma, M.J.M. Bonten

Objectives

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) improved intensive care unit (ICU), hospital and 28-day survival in ICUs with low levels of antibiotic resistance. Yet it is unclear whether the effect differs between medical and surgical ICU patients.

Methods

In an individual patient data meta-analysis, we systematically searched PubMed and included all randomized controlled studies published since 2000. We performed a two-stage meta-analysis with separate logistic regression models per study and per outcome (hospital survival and ICU survival) and subsequent pooling of main and interaction effects.

Results

Six studies, all performed in countries with low levels of antibiotic resistance, yielded 16 528 hospital admissions and 17 884 ICU admissions for complete case analysis. Compared to standard care or placebo, the pooled adjusted odds ratios for hospital mortality was 0.82 (95% confidence interval (CI) 0.72–0.93) for SDD and 0.84 (95% CI 0.73–0.97) for SOD. Compared to SOD, the adjusted odds ratio for hospital mortality was 0.90 (95% CI 0.82–0.97) for SDD. The effects on hospital mortality were not modified by type of ICU admission (p values for interaction terms were 0.66 for SDD and control, 0.87 for SOD and control and 0.47 for SDD and SOD). Similar results were found for ICU mortality.

Conclusions

In ICUs with low levels of antibiotic resistance, the effectiveness of SDD and SOD was not modified by type of ICU admission. SDD and SOD improved hospital and ICU survival compared to standard care in both patient populations, with SDD being more effective than SOD.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30477-9/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30477-9/pdf

 

June 12, 2018 at 8:07 am

Differential Contributions of Specimen Types, Culturing, and 16S rRNA Sequencing in Diagnosis of PJI.

Journal of Clincal Microbiology May 2018 V.56 N.5

Lone Heimann Larsena,b, Vesal Khalidc, Yijuan Xub,d, Trine Rolighed Thomsenb,d and Henrik C. Schønheydera,e the PRIS Study Group

aDepartment of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark

bCenter for Microbial Communities, Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark

cDepartment of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark

dBiotech, Danish Technological Institute, Aarhus, Denmark

eDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark

Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark

Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark

Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark

Danish Technological Institute, Biotech, Aarhus, Denmark

Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark

Department of Health Science and Technology, Faculty of Medicine, Aalborg University

Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Infection detection has been improved with modified culture methods and molecular diagnostics. However, comparisons between modified and conventional microbiology methods are difficult due to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ, and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study completion. Of the 156 patients enrolled, 111 underwent 114 surgical revisions (cases) due to indications of either PJI (n = 43) or AF (n = 71). Conventional tissue biopsy cultures confirmed PJI in 28/43 (65%) cases and refuted AF in 3/71 (4%) cases; one case was not evaluable. Based on these results, minor diagnostic adjustments were made. Fourteen-day cultures of JF, STB, and PC specimens confirmed PJI in 39/42 (93%) cases, and 16S rRNA sequencing confirmed PJI in 33/42 (83%) cases. One PJI case was confirmed with 16S rRNA sequencing alone and five with cultures of project specimens alone. These findings indicated that JF, STB, and PC specimen cultures qualified as an optimal diagnostic set. The contribution of sequencing to diagnosis of PJI may depend on patient selection; this hypothesis requires further investigation.

PDF

http://jcm.asm.org/content/56/5/e01351-17.full.pdf+html

May 9, 2018 at 3:39 pm

Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit, April 2014

2014-04 Enterobacterias Productoras de Carbaenemasas (EPC) – Herramientas para su Control y prevención 56 pags

Los expertos en control de infecciones y enfermedades infecciosas, así como aquellos preocupados por la seguridad del paciente y la mejora del rendimiento, pueden usar este conjunto de herramientas y desarrollar intervenciones para controlar Enterobacteriaceae resistentes a carbapenémicos (ERC). Las ERC son el resultado de una familia compleja de factores de resistencia transmitidos por plásmidos que circulan entre Enterobacteriaceae.

En los EEUU, la abrumadora mayoría de los casos de ERC son causados por el gen Klebsiella pneumoniae carbapenemase (KPC) transportado por el plásmido que circula entre las Enterobacteriaceae, principalmente entre esta familia de Klebsiella pneumoniae. Los organismos productores de KPC se han propagado de forma epidémica en los EEUU y en todo el mundo entre los pacientes hospitalizados.

FULL TEXT

https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cretoolkit/index.html

PDF

https://www.ahrq.gov/sites/default/files/publications/files/cretoolkit.pdf

 

May 6, 2018 at 6:11 pm

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

 

PDF

https://www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html

 

May 6, 2018 at 6:08 pm

Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures

Open Forum Infectious Diseases Winter 2018 V.5 N.1

Katie J Suda; Heather Henschel; Ursula Patel; Margaret A Fitzpatrick; Charlesnika T Evans

Fundamento

Las pautas para los antibióticos antes de los procedimientos dentales para pacientes con condiciones cardíacas y articulaciones protésicas específicas han cambiado, lo que reduce las indicaciones para la profilaxis con antibióticos. Además de las guias centradas en las comorbilidades de los pacientes, las revisiones sistemáticas específicas para las extracciones dentales y los implantes respaldan los antibióticos previos al procedimiento para todos los pacientes. Sin embargo, los datos sobre la adhesión del dentista a estas recomendaciones son escasos.

Métodos

Este fue un estudio transversal de veteranos sometidos a extracciones dentales, implantes dentales y procedimientos periodontales. Se excluyeron los pacientes que recibieron ATB para infecciones orales o no orales. Los datos fueron recolectados a través de una revisión manual del registro de salud.

Resultados

De 183 veteranos (edad media, 62 años, 94,5% varones) sometidos a los procedimientos incluidos, el 82,5% recibió profilaxis con ATB (duración media, 7,1 ± 1,6 días). Amoxicilina (71.3% de los ATB) y la clindamicina (23.8%) se prescribieron con mayor frecuencia; El 44.7% de los pacientes prescritos a clindamicina no fueron etiquetados como penicilina alérgico. De los que recibieron profilaxis, el 92.1% recibió ATB posteriores al procedimiento solamente, el 2.6% recibió ATB previos al procedimiento solamente y el 5.3% recibió ATB antes y después del procedimiento. Cuando se indicó la profilaxis, el 87,3% de los pacientes recibió un ATB. Sin embargo, el 84,9% recibió ATB después del procedimiento cuando se indicó la administración previa al procedimiento. Si bien la mayoría de los ATB estaban indicados, solo el 8,2% de los pacientes recibieron ATB de manera apropiada. La razón principal fue secundaria a la duración prolongada. Tres meses después del procedimiento, no hubo casos de infección por Clostridium difficile, endocarditis infecciosa, infecciones articulares protésicas o infecciones orales posteriores al procedimiento.

Conclusión

La mayoría de los pacientes sometidos a un procedimiento dental recibieron profilaxis antibiótica según lo indicado. Aunque los pacientes para los que se indicó profilaxis con ATB deberían haber recibido una sola dosis antes del procedimiento, la mayoría de los ATB se prescribieron después del procedimiento. Los esfuerzos de la administración dental deben garantizar el tiempo, la indicación y la duración adecuados de los ATB.

FULL TEXT

https://academic.oup.com/ofid/article/5/1/ofx250/4633784

PDF  (CLIC en PDF)

 

April 1, 2018 at 3:04 pm

REVIEW – Environmental cleaning and disinfection of patient areas

International Journal of Infectious Diseases Ferbuary 2018 V.67 P.52–57

Michelle Doll, Michael Stevens, Gonzalo Bearman

Abstract

The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients.

Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections.

While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30270-9/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30270-9/pdf

February 10, 2018 at 9:18 am

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